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1528697596
JACOB JAMES HENDERSON
MEDFORD, OR
NPI
1528697596
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2020-04-02
Last Update Date
2020-04-02
Business Address
Mr. JACOB JAMES HENDERSON
777 MURPHY RD
MEDFORD, OR 97504-8425
Phone number: 541-772-2763
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Mailing Address
Mr. JACOB JAMES HENDERSON
777 MURPHY RD
MEDFORD, OR 97504-8425
Phone number: 541-772-2763
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